Higher vegetable (V) intake has been related to lower risk of diabetes, cardiovascular disease and several cancers and obesity. Dietary behaviors initiated in early childhood may persist into adulthood, thereby impacting the risk of chronic diseases. By 3 years of age , many children have developed a dislike for certain foods, particularly V13-16. Seventy-five percent of young children are consuming less than the recommended levels for V with median intakes less than 1 cup per day. French-fries constituted about 23% of all V consumed. Many preschool children are reluctant not only to eat V, but to taste V, which is reflected in the very low intakes of V observed in this age group16. The proposed research focuses on increasing V consumption in 2 low-income minority groups, African- (AA) and Hispanic-Americans (HA) that have disproportionately higher risk for developing obesity and cancers later in life. Since children's food preferences and practices are initiated early in life (e.g. 2 to 5 y), early dietary intervention programs will have immediate nutritional benefit for young children, and should reduce chronic disease risk when the learned habits are carried into adult years. An underused health education approach involves drama or theatre performances in the school setting for educating children. Several studies used theatre productions to educate adolescents on topics such as HIV/AIDS, teen pregnancy, dental health, smoking, and drug and alcohol use. Only one study used theatre to change food related knowledge and food choices concerning V among children in grades 1-6. The theatre intervention made a substantial impact on children's reported food choices, but unfortunately, this study used a design without a control group. Theatre performances are a promising approach for engaging children with messages about healthy eating. Theatre interventions appear to be most effective when they involve a story (also called narrative). Narrative or any 2 events arranged in a chronological or casual sequence, is the most basic form of human communication. Narratives unique immersive capacity allows for engendering arousal and attention;helps create a deep affection for the characters;and absorbs the players in an immersive fictional world. Compared to live puppet shows, videotaped puppet shows are relatively inexpensive to reproduce and can be shown to a wider audience numerous times in a variety of settings. Moreover, the audience gets exposed to the same puppet show with all the key messages;thus the intervention is more standardized. The PUPPET study is a dietary change intervention targeted at children in Head Start (HS). The goal of this study is to test the feasibility of an innovative approach to increase the amount of preferred (healthy) V consumed by preschool children who are predominantly low-income AA and HA. The primary endpoint will be changes in V consumption in HS with the hypothesis that a PUPPET intervention with a parent/teacher component will increase V consumption in preschool children.

Public Health Relevance

Higher vegetable intake has been related to lower risk of diabetes, cardiovascular disease, several cancers, and obesity. Since children's food preferences and practices are initiated early in life (e.g., 2 to 5 years), early dietary interventon programs will have immediate nutritional benefit for young children, and should reduce chronic disease risk when the learned habits are carried into adult years. The proposed research will test the feasibility of an innovative approach to increase the amount of preferred vegetables consumed in low-income preschool children.